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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS 1 <br /> r� /� f Rush Analysis: 5 Days _2 Days 24hrs <br /> Client:�l L ( /./d ^�.e/Soi. �1�1$SDC , 7,7�,r__7.,ft. <br /> (s): f' � C_ Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> // omp ampler Set Up Date: ime:_ <br /> Address: ZZ JA I. 4aA� LTime: Mileage: _1Z:6D If yes,To: State—Client —Other <br /> p• 1 <br /> ) J: , SSzYa - Lab number: <br /> Phone: �1930 - 3701 <br /> � - z <br /> FAX: (2o`) 36y ' ` ?Z� A 3 <br /> a a <br /> 1 <br /> l��eiC��l '��✓cK <br /> Project name y U d g h x <br /> ,�— n i f <br /> Contact person: r n` K a ("-x <br /> SAMPLE INFORMATION <br /> Sample Date Time fi¢ 4 <br /> Number Location Description Sample sample z°> a � 0 a d> v <br /> Relinquished by: Date .. d Time/)"5's Received by: _ Date.hC�Time )' SS- <br /> Relinquished by: Date _Time Received by: Date J 1 b3rime <br /> Relinquished by: Date —Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite B2* Stockton CA 95210 *Telephone(209)477-8105*FAX:(209)477-8148 <br />